Laurie Garrett is Senior Fellow for Global Health at the Council on Foreign Relations and is the author of The Coming Plague and Betrayal of Trust. [contact:ask_author]

Q: What would precipitate a deadly flu pandemic and how likely is it to occur in the foreseeable future?

The H5N1 avian flu strain, so deadly to fowl and domesticated poultry, needs to mutate further, acquiring traits that make it a contagious human-to-human strain. We have no idea what exact genetic changes this would require, how difficult it is for the virus to make those changes and whether or not the virus would significantly sacrifice its virulence level in the process. The bottom line for policymakers: Science does not know the answer.

Q: Are there measures that if taken could prevent the deadly flu from spreading globally?

At the recent World Health Assembly in Geneva, this was the number one question on the minds of delegates from 192 nations, especially the U.S. delegates. The World Health Assembly, which governs the World Health Organization (WHO), passed two resolutions to create a worldwide infrastructure of surveillance labs and monitoring and response processes. But funding is nonexistent at this time, and the WHO has only a small permanent rapid response team (although it expands during times of crisis).

Q: If an outbreak does occur, what is the state of preparedness planning between nations, across regions, among departments and ministries of individual governments and throughout the non profit sectors?

Planning is abysmally inadequate, given the likely severity of a pandemic caused by a human-to-human transfer of a virus as virulent as the current H5N1 strain.

Q: Without adequate preparations, what would be the likely toll of such a pandemic globally and in the United States?

The answer depends on the virulence level of the pandemic virus. The 1918 strain, which killed 50 to 100 million people, only killed about two to three percent of the people it infected. The H5N1 strain now in circulation kills 100 percent

Fatou Bensouda, the chief prosecutor at the International Criminal Court, talks to Foreign Affairs about the court’s achievements and challenges, why so few people have been convicted, and whether the court has a bias against Africa.